Tobacco smoking is a common risk factor (RF) for the development of both cardiovascular and chronic lung diseases. Aim: to study the effect of smoking on the state of vascular endothelium, the severity of oxidative stress and inflammatory activation in patients with a combination of bronchial asthma (BA) and coronary heart disease (CHD). Materials and methods. This study included 80 patients with a combination of BA and CHD (44 smokers and 36 non-smokers) and 50 healthy non-smokers. All subjects underwent a comprehensive study of the parameters of oxidative stress (peroxidation of proteins, lipids, and antioxidant protection), inflammatory activation (C-reactive protein and fractalkine) and vasoregulatory function of the vascular endothelium (endothelial function coefficient, endothelin-1 and type C natriuretic peptide). Results. In smokers and non-smokers with a combination of BA and CHD, we revealed biochemical (increased production of endothelin-1 and type C natriuretic peptide) and instrumental (coefficient of endothelial function less than 1) signs of endothelial dysfunction, which were significantly more pronounced in the subgroup of smoking patients Also, in patients with a combination of BA and CHD, an increase in markers of systemic inflammation (C-reactive protein, fractalkine) and an increase in the severity of oxidative stress in the smoking patients subgroup were registered, which was indicated by an increase in the level of protein and lipid peroxidation products and a decrease in superoxide dismutase activity not only in comparison with a control group, but also with a subgroup of non-smoking patients with a combination of BA and CAD. Conclusion. In the subgroup of smoking patients, a greater severity of endothelial dysfunction was noted. Effect of smoking on the activation of systemic inflammation and oxidative stress in patients with a combination of BA and CHD has been established. The results of the correlation analysis revealed the association of the presence and intensity of smoking in patients with BA and CHD both with indices of the state of vascular endothelium and indices of the activity of systemic inflammation and oxidative stress.